view Unit 19: Postpartum and Postabortion Family Planning

19.7 Postpartum Contraception Options for Women Living
with HIV/AIDS
• In general, women living with HIV/AIDS can use any hormonal method—COCs, POPs,
progestin-only injectables, contraceptive implants—with some restrictions for women on
ARV therapy. (See table below.)
• LAM: If replacement feeding is acceptable, feasible, affordable, sustainable, and safe
(AFASS), women living with HIV should avoid breastfeeding and not rely on LAM. But if
replacement feeding does not meet these conditions, a woman living with HIV should
breastfeed exclusively for the first 6 months, thereby using LAM (until her menses
resumes).
• FAM: Women who are infected with HIV, have AIDS, or are on ARV therapy can safely use
fertility awareness methods after 3 menstrual cycles or normal secretions have returned.
• Condoms: All clients, including clients living with HIV, should be counselled on condom use
for dual protection and to prevent transmission of HIV to partners.
The WHO MEC classifications for hormonal methods and copper-bearing IUCDs for women at
high risk for or living with HIV are listed in Table 19.2.
Table 19.2: MEC Classifications for Women Living with or at High Risk of HIV
HIV Status/Condition MEC Categories for
Hormonal Methods
MEC Categories for
Copper-Bearing IUCD
High risk of HIV: Category 1 Category 2
HIV infected Category 1 Category 2
Has AIDS Category 1 Category 3 for insertion, Category 2 for
continued use
Clinically well on
antiretroviral therapy
Not clinically well on
antiretroviral therapy
Category 2*
Category 2*
Category 2 for insertion and continued use
Category 3 for insertion, Category 2 for
continued use
* The exception to this is if the woman is using Ritonavir-boosted protease inhibitors. In
these cases, use of COCs and POPs is contraindicated (MEC category 3). Use of implants for
these women is Category 2 and use of DMPA is Category 1.
19.8 Defining Postabortion Family Planning
Postabortion family planning is the initiation and use of family planning methods at the time of
treatment for an abortion, or before fertility returns after an abortion (within 11-14 days after
the abortion occurred).
Importance of postabortion family planning
Women who have just experienced abortion or who have just been treated for postabortion
complications need immediate and easy access to family planning services. Ideally, these
services should be integrated with postabortion care and offered immediately postabortion,
increasing the likelihood that these women use contraception to avoid unintended pregnancy.
(WHO/RHR and CCP, INFO Project 2007).
Unit 19: Postpartum and Postabortion Family Planning 425